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Wednesday, July 04, 2012

independence day

I did want to put the birth announcement up here first, as this is something of my Primary Address when it comes to the internet, but something was weird with the wireless network at the hospital and my computer couldn't connect, blah blah blah (now I'm just boring myself) and besides, everyone is on Facebook and Twitter anyway, right? But just because I'm a completist when it comes to documentation:

(Her Chinese middle name, picked out by my dad, means "witty" and "intelligent." We figured she'd have a lifetime of people telling her that she was "pretty"--I mean, not that we knew she would be pretty, though she is, but you know what I mean, people always tell little girls that--and we wanted to pick a middle name that would emphasize that there are more important things. When it comes to first names, we don't make a big thing about choosing first names that have a lot of symbolism, we just go by the "like the way it sounds" school of baby naming, but so far as I can tell, Nina means "girl." So, you know, story checks out.)

Nina came into the world in her own way, which I am coming to understand is determinedly unique and certainly on her own timetable. You remember I was admitted to the hospital for about 12 hours in what was first deemed to be active and then downgraded to a sort of meandering prodromal labor last week--and I spent the time since then doing exactly what I didn't want to do with the final stages of my pregnancy, which was puttering around, hyperaware of my body, and sort of obsessively cataloguing every squeeze and twinge and thump. This is so annoying, I thought to myself. If I was at work, I'd be busy, I'd have more to do than naval-gazing, and I wouldn't be so focused on every little thing going on all up in my junk. This is a waste of time.

(She said with great PORTENT.)

Sunday morning--the day I turned 38 weeks--I woke up, and Nina, intrauterine, was still asleep. I had gotten pretty accustomed to her sleep/wake patterns by this time, and usually she would perk up and start kicking around pretty soon after I got up myself, but this morning, she was a little slow to get going. So I did the usual things they tell you to do. I had some breakfast. I had some coffee. I started counting her kicks. It wasn't that she wasn't moving around AT ALL--obviously that would have been very worrisome--she was meeting her minimum kick count, which I believe is 10 movements in 2 hours, but it was just different from usual. She was just kind of pokey in there.

I know that decreased movement at term can be normal--there's just less room in there, after all, and who knows, maybe they sense when birth is imminent and quiet down to save energy for getting borned and all that. But it was still a change, and though I considered long and hard just going about my day (see above: with the lack of my usual daily runaround, maybe I was just being too obsessive about what was going on inside) but in the end decided to just call my OB and get his opinion.

Sidebar: I cannot recommend my OB highly enough, by the way. I can talk about it more with anyone who wants a recommendation, but his name is Dr. Brad Moore, here is the website for his office, and he is truly an excellent clinician and bedside doctor--and this is from someone who is well aware of the Pressures of Modern Medicine and therefore very forgiving when it comes to how other clinicians practice. He is quite simply and unequivocally excellent, so get thee to his practice, pregnant ladies of Atlanta. End sidebar.

Anyway, I called my OB, kind of apologizing for calling on the weekend about something that could be nothing, I'm not a hysteric, I swear, but he listened and he did take it seriously. "Come on in,"he told me, "we'll check you and check the baby. You're 38 weeks, contracting, with advanced dilation, GBS positive and a history of fast labors. If things are in line, maybe we'll just get in your antibiotics, augment you with a whiff of Pitocin, and have this baby tonight."

I think his intent had been for me to check into L&D right from the beginning (since he was on call that weekend he was already in the hospital, puttering around) but because my chief complaint was "decreased fetal movement at term" they sent me to triage first, where the nurse was very clearly of the opinion that I was a hysteric and should be sent home. "The best outcome here would be to send you home," she told me brightly with one of those tight, forced smiles as she was doing the admissions paperwork, and after she got the phone orders from my OB that I should indeed be admitted to L&D, she made it clear that she disagreed in the way that people do without coming out and saying so outright. "Well, you're getting admitted. It's what your doctor wants, I guess..." I don't begrudge her the sentiment--I don't like being on call for the weekend either, I guess--but I was also glad that I'd called my OB first and that the decision was not up to her.

The actual lead up to delivery was completely uneventful, much with with Cal and Mack. I got my antibiotics, started some low-dose Pitocin, got my epidural (great stuff, by the way, though it's not an entirely pleasant process getting it placed, and fact that I'm pleased to be reminded of every 3.5 years just for the purposes of patient empathy) and then had my membranes ruptured with my second dose of penicillin hanging. We were on our way. At 11:56, the baby's head was at +2, all the players were in the room, and we were ready to push.

"We've still got four minutes to make a July 1st birthday!" Joe kidded, and my OB made a little jokey show of putting on his glove and gowns real fast. Then we started pushing.

I should mention that up until this point, for the hours we'd been there, the fetal heartbeat monitor was looking really good. Lots of good variability, perky, with a rate right in the normal range. When the head was all the way down and we started getting ready to push however, the tracing looked a little more flat, meaning that the rate was still normal, but it wasn't quite as variable as it had been. I assumed she just didn't like getting squashed. But then after the first two rounds of pushing, it all kind of fell off a cliff.

Even in an adult, a heart rate of 50 in an adult is slow. That's what Joe's heart rate is, and he's on beta blockers, for chrissake. A heartrate of 50 in a neonate is...well. Let's just say that if I was in the NICU and there was a baby with a heart rate of 50, I would be doing chest compressions on that baby. After the first two pushes, that's what our baby's heart rate did on the monitor. The nurse adjusted the Doppler, thinking maybe that the baby was so low down that it wasn't picking up, but no, it was picking up, and it was 50. So my OB--in a way that was very calm but also very quick and decisive, and I'm convinced that it was this quick response that really saved us from those things we don't like to think about--busted out the obstetric vacuum, applied it to the baby's head, told me to push one more time quick, and pulled that puppy out of there.

Nina was born vigorous, with good tone, and she cried right away. Her Apgars were 8 and 9. As they were warming her up and drying her off, I heard my OB, from the region I like to call Down There, say, "Oh my gosh, look at this." Which is not a thing that I like to hear from Down There. Because when he delivered the rest of the placenta and cord, it looked like this:

(Let me just insert here that this is not a picture of our umbilical cord, it's a picture I got off Ye Internet, though ours looked remarkably similar, only tighter. That is not to say that we didn't take pictures of this phenomenon, because WE TOTALLY DID, once the placenta and associated works were safely and discreetly deposited in the specimen basin, but they're on our "real" camera and I can't figure out how to get them off, because someone switched the settings so that all our photos from that day are in RAW format. If someone knows a good strategy to batch convert them in Photoshop so we don't have to do them one by one, let me know in the comments section, thanks--I'll update with those photos once I'm able to extract them.)

In case you can't see for yourself, it was a knot. What they call a true knot in the umbilical cord, which is pretty rare, and even rarer for it to actually get pulled tight enough to manifest with fetal distress. The knot had probably already been there for months--Nina had probably tied it earlier in gestation when she was much smaller and there was more room to maneuver, and if you don't read about all the terrible things that can happen with a true knot in the umbilical cord, it's actually a little amusing to thing about her doing the loop-de-loop, then threading the needle while swinging her cord around like a lariat. A little amusing, until she started to pull down on the cord on her way out and tightened that knot up but good. Obviously we had no idea until after, it's not exactly something you screen for routinely without lack of other indicators for risk, and there's nothing you can really do to cause or prevent it. We were incredibly lucky, and we know it.

I also do have to say this here, because these days, what my friend Veronica (also an OB-Gyn) has called "the fetishization of the natural" goes hand in hand with the demonization of the medical. By no means am I saying that everyone should have the maximal interventions possible (Pitocin and epidurals and C-sections for everyone!) or that people's hearts aren't in the right places when they choose to have births outside of the hospital. But if I were of the type to elect for a home birth (and let's be clear: I'M TOTALLY NOT) I would have, on paper, been the perfect candidate. Multiparous with two prior uncomplicated vaginal deliveries, full-term with normal-sized fetus and an uncomplicated gestation. But if this pregnancy experience has taught me anything, it's that you can't plan for everything, and there's always going to be things you can't expect. And maybe because it's the anesthesiologist's credo (aside from vigilance), but I live by the idea of hoping for the best and planning for the worst.

This could have been bad. It could have been catastrophic. But it was not, and for that, and for our sweet baby Nina, we could not be more grateful.

Cal, upon meeting Nina for the first time in the hospital the next day, gave this assessment. (Cal's demeanor is often overly serious--we keep telling him to lighten up, kid, for god's sake--and while we mentioned to him about the interesting little finding on Nina's umbilical cord we didn't really go into detail about what it could have meant; Cal's grave little pronouncements just happen on their own.)

"She's perfect." he told me. "She's the perfect baby and we get to take her home with us."

Congrats! And, as a pediatric neurologist who's seen her share of birth catastrophe, I agree, so scarey! Reminds me of the birth of my daughter 9 months ago -- at the end, with each contraction, she was having variable decels. I know these are not supposed to be that concerning, but her heart rate would slow slow slow STOP, then gradually pick up each time. The nurse tried to tell me it was just the monitor losing it when she moved with the contraction, but giving the very obvious and dramatic deceleration and acceleration with each one, I doubt her claim. And, as the babies heart rate hung out in the 50s - 60s for almost a minute with each decel, I though exactly what you did --that if she were not inside of me, we'd be doing chest compressions. Not the most reassuring thought to have in the middle of labor. But, she's fine and so is Nina. Congrats again!

Congratulations!! I love the picture of Cal holding her. He looks proud. And the one of Mack in his Green Lantern mask just cracks me up.

Hint: If you haven't figured out how to convert a batch of RAWs in Photoshop, save the pics all to one folder then select "File -> Scripts -> Image Processor"Select the folder the RAWs are in, select JPEG, and let Photoshop do it's thing :)

Delurking for the first time after years of reading to say congratulations on lovely little Nina!! Glad everything worked out for the best. Looking forward to reading all about her and how your adorable boys adjust.

Also, re: RAW to jpg--if you have Lightroom, you can easily import them all and then export them as any size jpg (you'll want to limit the file size; raw files are gigantic). Or in Photoshop, you can use Image Processor: http://help.adobe.com/en_US/photoshop/cs/using/WSfd1234e1c4b69f30ea53e41001031ab64-7427a.html

A warm welcome to Nina and congratulations Michelle!I have to admit, I'm not the "Ahhhhhh and ohhhhhhhhhh how cute"-type but Nina looks really adorable and so tiny and at the same time much more mautre and less baby-like. What an amazing kid!Enjoy your family time!

How scary! Glad all worked out well for your family. Nina is beautiful.

I also has an ideal low risk pregnancy with my first when I was in my 20s. I continued running, weight gain was great and blood pressure at the 24 week appt was normal. Fast forward to 28 weeks when I was admitted with bp of 160/100 and remained stable just long enough to be beta complete before developing HELLP and hemorrhaging during an emergency c-section 2 days later. My son, despite being premature and 1 lb 10 oz at birth came home 78 days later perfectly healthy. I do believe people should be able to choose but I just can't fathom choosing take that kind of risk with my child for the "experience" of being able to burn incense, eat and listen to Enya.

Oh my. When I saw that knot I actually gasped. I didn't know that could happen, and it is scary to think about! Your doctor sound fantastic and very good. And Nina looks very intent and curious. Such an adorable nose, too. Congratulations!

Congratulations, and so glad she is here safely. She's beautiful and so is her name. My mother was Nean and my beautiful daughter-in-law is Nina, so I heartily approve. Great to have a scary story with a good ending. Cal looks so mature in those pictures. How'd he get so much beyond the babyhood picture we knew him as. Also thanks for the referral. My gyn of 23 years will be retiring soon and I have been at a loss as what to do.

Extremely cute. I second one of your readers, you and Joe make cute babies. In some pics, she looks like a mini-Mac - exact replica. (Not so grumpy-looking though ahahah). I'm glad you and the bub are fine. :D

Congrats!!! How cool is she? And how cool is that cord, although terrifying. I am glad you had an excellent OB and you delivered her safely. She's beautiful.

I love your blog and have gone back all the way to the beginning to read your adventures from then until now. I almost feel like you're a good, old friend. It's wonderful to see your happy family and I can't wait to read about this next chapter in your life.

Congratulations!! Nina was on our shortlist for girl names too. Scary story. We also had one of those moments after delivery where we realized how close we came to a tragedy. (And I am with you on the "fetishization of the natural." Several of the nurses congratulated me on a successful VBAC, but knowing what I know now about the impact my vaginal birth had on the baby's health and on my health, if I could go back in time I would opt for a C-section.)

Oh, Michelle. I am so glad for you that you followed your instincts and got checked out on Sunday, and that Nina is healthy. One of my friends (who, ironically, was a proponent of homebirth and against medical intervention for the birth of her first child) had bleeding at 38 1/2 weeks with her second, went to the hospital and he was stillborn from a cord accident, probably from a true knot and velamentous cord insertion. I know you don't need to be told how fortunate you guys are that nothing bad happened to Nina. I am just so glad for you that you delivered before anything bad happened. She is just beautiful. Congratulations and best wishes to you and yours!

Wow, I'm so glad everything turned out perfectly! Nina is a beautiful baby and that last picture of your family made me smile so much.

I'm in medical school right now (2nd year) and you are a huge inspiration to me. I've started reading from the beginning and slowly going back to present time (also just ordered your book!). Please keep blogging - it really is a joy to read!

Congrats! I'm so glad you wrote this post.It is terrifying that people who don't know anything about medicine, really, doin't know anything, opine in such authoritative ways about matters medical, in a way that pressures women to "demedicalize" birth in order to live up to their feminist ideals. These are not people who actually know what complications can be part of "normal" birth and delivery, how to manage them, or what the limits of medicine are in managing them. They just seem captivated by an idea about how the body works - in much the same way I know was captivated by my idea of "medical stories" before I actually went to med school and became a doctor. I hope reading this dissuades some women from birthing in a bathtub at home with a BA-educated doula who would have no way of coping with a disaster except for calling 911.

Congratulations on Thing 3. I just started my OBGYN rotation and completely understand where you are coming from with the fetishisation of the natural. Hope her bilirubin comes down and your biggest worry will be waking up at ungodly hours to feed her.

Congratulations! I have a little sister named Nina (just like Cal and Mack do!), and it's such a great name! In about two or three years, you'll have to get the book series about a little ballerina named Nina- I'm pretty sure my sister, now in law school, still has them on her bookshelf.

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